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Koen Nieman - One of the best experts on this subject based on the ideXlab platform.
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noninvasive assessment of plaque morphology and composition in culprit and Stable lesions in acute coronary syndrome and Stable lesions in Stable Angina by multidetector computed tomography
Journal of the American College of Cardiology, 2006Co-Authors: Udo Hoffmann, Ricardo C Cury, Fabian Moselewski, Koen Nieman, Ikkyung Jang, Maros Ferencik, Ayaz Rahman, Suhny Abbara, Hamid Joneidijafari, Stephan AchenbachAbstract:Objectives The purpose of this study was to assess morphology and composition of culprit and Stable coronary lesions by multidetector computed tomography (MDCT). Background Noninvasive identification of culprit lesions has the potential to improve noninvasive risk stratification in patients with acute chest pain. Methods Thirty-seven patients with acute coronary syndrome (ACS) or Stable Angina underwent coronary 16-slice MDCT and invasive selective angiography. In all significant coronary lesions two observers measured the degree of stenosis, plaque area at stenosis, and remodeling index and assessed plaque composition. Differences between culprit lesions in patients with ACS and Stable lesions in patients with ACS or Stable Angina were determined. Results We analyzed 40 lesions with excellent image quality in 14 patients with ACS and 9 patients with Stable Angina. Culprit lesions in patients with ACS (n = 14) had significantly greater plaque area and a higher remodeling index than both Stable lesions in patients with ACS (n = 13) and in patients with Stable Angina (n = 13) (17.5 ± 5.9 mm 2 vs. 9.1 ± 4.8 mm 2 vs. 13.5 ± 10.7 mm 2 , p = 0.02; and 1.4 ± 0.3 vs. 1.0 ± 0.4 vs. 1.2 ± 0.3, p = 0.04, respectively). The prevalence of non-calcified plaque was 100%, 62%, and 77%, respectively, and the prevalence of calcified plaque was 71%, 92%, and 85%, respectively, in culprit lesions in patients with ACS and in Stable lesions in patients with ACS or Stable Angina. Conclusions We introduce the concept of noninvasive detection and characterization of coronary atherosclerotic lesions in patients with ACS by MDCT. We identified differences in lesion morphology and plaque composition between culprit lesions in ACS and Stable lesions in ACS or Stable Angina, consistent with previous intravascular ultrasound studies.
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noninvasive assessment of plaque morphology and composition in culprit and Stable lesions in acute coronary syndrome and Stable lesions in Stable Angina by multidetector computed tomography
Journal of the American College of Cardiology, 2006Co-Authors: Udo Hoffmann, Ricardo C Cury, Fabian Moselewski, Koen Nieman, Ikkyung Jang, Maros Ferencik, Ayaz Rahman, Suhny Abbara, Hamid Joneidijafari, Stephan AchenbachAbstract:Noninvasive Assessment of Plaque Morphology and Composition in Culprit and Stable Lesions in Acute Coronary Syndrome and Stable Lesions in Stable Angina by Multidetector Computed TomographyUdo Hoff...
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multislice spiral computed tomography coronary angiography in patients with Stable Angina pectoris
Journal of the American College of Cardiology, 2004Co-Authors: Nico R Mollet, Eugene P Mcfadden, Koen Nieman, Filippo Cademartiri, Francesco Saia, Pedro A Lemos, Peter M T Pattynama, Patrick W Serruys, Gabriel P Krestin, Pim J De FeyterAbstract:Abstract Objectives This study was designed to prospectively evaluate the diagnostic performance of multislice spiral computed tomography (MSCT) coronary angiography for the detection of significant lesions in all segments of the coronary tree potentially suitable for revascularization. Background Noninvasive MSCT coronary angiography is a promising coronary imaging technique. Methods Sixteen-row MSCT coronary angiography was performed in 128 patients (89% men, mean age 58.9 ± 11.7 years) in sinus rhythm with Stable Angina pectoris scheduled for conventional coronary angiography. Sixty percent (77 of 128) of patients received pre-scan oral beta-blockers, resulting in a mean heart rate of 57.7 ± 7.7 beats/min. The diagnostic performance of MSCT for detection of significant lesions (≥50% diameter reduction) was compared with that of quantitative coronary angiography (QCA). Results The sensitivity of MSCT for detection of significant lesions was 92% (216 of 234, 95% confidence interval [CI]: 88 to 95). Specificity was 95% (1,092 of 1,150, 95% CI: 93 to 96), positive predictive value 79% (216 of 274, 95% CI: 73 to 88), and negative predictive value 98% (1,092 of 1,110, 95% CI: 97 to 99). Two ≥50% lesions were missed because of motion artifacts and two because of severe coronary calcifications. The rest (78%, 14 of 18) were detected but incorrectly classified as Conclusions Sixteen-row MSCT coronary angiography permits reliable detection of significant obstructive coronary artery disease in patients with Stable Angina in sinus rhythm.
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multislice spiral computed tomography coronary angiography in patients with Stable Angina pectoris
Journal of the American College of Cardiology, 2004Co-Authors: Nico R Mollet, Eugene P Mcfadden, Koen Nieman, Filippo Cademartiri, Francesco Saia, Pedro A Lemos, Peter M T Pattynama, Patrick W Serruys, Gabriel P Krestin, Pim J De FeyterAbstract:Objectives This study was designed to prospectively evaluate the diagnostic performance of multislice spiral computed tomography (MSCT) coronary angiography for the detection of significant lesions in all segments of the coronary tree potentially suitable for revascularization. Background Noninvasive MSCT coronary angiography is a promising coronary imaging technique. Methods Sixteen-row MSCT coronary angiography was performed in 128 patients (89% men, mean age 58.9 ± 11.7 years) in sinus rhythm with Stable Angina pectoris scheduled for conventional coronary angiography. Sixty percent (77 of 128) of patients received pre-scan oral beta-blockers, resulting in a mean heart rate of 57.7 ± 7.7 beats/min. The diagnostic performance of MSCT for detection of significant lesions (≥50% diameter reduction) was compared with that of quantitative coronary angiography (QCA). Results The sensitivity of MSCT for detection of significant lesions was 92% (216 of 234, 95% confidence interval [CI]: 88 to 95). Specificity was 95% (1,092 of 1,150, 95% CI: 93 to 96), positive predictive value 79% (216 of 274, 95% CI: 73 to 88), and negative predictive value 98% (1,092 of 1,110, 95% CI: 97 to 99). Two ≥50% lesions were missed because of motion artifacts and two because of severe coronary calcifications. The rest (78%, 14 of 18) were detected but incorrectly classified as <50% obstructions. All patients with and 86% (18 of 21) of patients without significant lesions on QCA were correctly classified by MSCT. All patients with significant left main disease or total occlusions were correctly identified on MSCT. Conclusions Sixteen-row MSCT coronary angiography permits reliable detection of significant obstructive coronary artery disease in patients with Stable Angina in sinus rhythm.
Pim J De Feyter - One of the best experts on this subject based on the ideXlab platform.
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multislice spiral computed tomography coronary angiography in patients with Stable Angina pectoris
Journal of the American College of Cardiology, 2004Co-Authors: Nico R Mollet, Eugene P Mcfadden, Koen Nieman, Filippo Cademartiri, Francesco Saia, Pedro A Lemos, Peter M T Pattynama, Patrick W Serruys, Gabriel P Krestin, Pim J De FeyterAbstract:Abstract Objectives This study was designed to prospectively evaluate the diagnostic performance of multislice spiral computed tomography (MSCT) coronary angiography for the detection of significant lesions in all segments of the coronary tree potentially suitable for revascularization. Background Noninvasive MSCT coronary angiography is a promising coronary imaging technique. Methods Sixteen-row MSCT coronary angiography was performed in 128 patients (89% men, mean age 58.9 ± 11.7 years) in sinus rhythm with Stable Angina pectoris scheduled for conventional coronary angiography. Sixty percent (77 of 128) of patients received pre-scan oral beta-blockers, resulting in a mean heart rate of 57.7 ± 7.7 beats/min. The diagnostic performance of MSCT for detection of significant lesions (≥50% diameter reduction) was compared with that of quantitative coronary angiography (QCA). Results The sensitivity of MSCT for detection of significant lesions was 92% (216 of 234, 95% confidence interval [CI]: 88 to 95). Specificity was 95% (1,092 of 1,150, 95% CI: 93 to 96), positive predictive value 79% (216 of 274, 95% CI: 73 to 88), and negative predictive value 98% (1,092 of 1,110, 95% CI: 97 to 99). Two ≥50% lesions were missed because of motion artifacts and two because of severe coronary calcifications. The rest (78%, 14 of 18) were detected but incorrectly classified as Conclusions Sixteen-row MSCT coronary angiography permits reliable detection of significant obstructive coronary artery disease in patients with Stable Angina in sinus rhythm.
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multislice spiral computed tomography coronary angiography in patients with Stable Angina pectoris
Journal of the American College of Cardiology, 2004Co-Authors: Nico R Mollet, Eugene P Mcfadden, Koen Nieman, Filippo Cademartiri, Francesco Saia, Pedro A Lemos, Peter M T Pattynama, Patrick W Serruys, Gabriel P Krestin, Pim J De FeyterAbstract:Objectives This study was designed to prospectively evaluate the diagnostic performance of multislice spiral computed tomography (MSCT) coronary angiography for the detection of significant lesions in all segments of the coronary tree potentially suitable for revascularization. Background Noninvasive MSCT coronary angiography is a promising coronary imaging technique. Methods Sixteen-row MSCT coronary angiography was performed in 128 patients (89% men, mean age 58.9 ± 11.7 years) in sinus rhythm with Stable Angina pectoris scheduled for conventional coronary angiography. Sixty percent (77 of 128) of patients received pre-scan oral beta-blockers, resulting in a mean heart rate of 57.7 ± 7.7 beats/min. The diagnostic performance of MSCT for detection of significant lesions (≥50% diameter reduction) was compared with that of quantitative coronary angiography (QCA). Results The sensitivity of MSCT for detection of significant lesions was 92% (216 of 234, 95% confidence interval [CI]: 88 to 95). Specificity was 95% (1,092 of 1,150, 95% CI: 93 to 96), positive predictive value 79% (216 of 274, 95% CI: 73 to 88), and negative predictive value 98% (1,092 of 1,110, 95% CI: 97 to 99). Two ≥50% lesions were missed because of motion artifacts and two because of severe coronary calcifications. The rest (78%, 14 of 18) were detected but incorrectly classified as <50% obstructions. All patients with and 86% (18 of 21) of patients without significant lesions on QCA were correctly classified by MSCT. All patients with significant left main disease or total occlusions were correctly identified on MSCT. Conclusions Sixteen-row MSCT coronary angiography permits reliable detection of significant obstructive coronary artery disease in patients with Stable Angina in sinus rhythm.
Julius M Gardin - One of the best experts on this subject based on the ideXlab platform.
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acc aha 2002 guideline update for the management of patients with chronic Stable Angina summary article a report of the american college of cardiology american heart association task force on practice guidelines committee on the management of patients with chronic Stable Angina
Circulation, 2003Co-Authors: Raymond J Gibbons, Jonathan Abrams, Kanu Chatterjee, Jennifer Daley, Prakash Deedwania, John S Douglas, Bruce T Ferguson, Stephan D Fihn, Theodore D Fraker, Julius M GardinAbstract:The Clinical Efficacy Assessment Subcommittee of the American College of Physicians–American Society of Internal Medicine acknowledges the scientific validity of this product as a background paper and as a review that captures the levels of evidence in the management of patients with chronic Stable Angina as of November 17, 2002. The American College of Cardiology (ACC)/American Heart Association (AHA) Task Force on Practice Guidelines regularly reviews existing guidelines to determine when an update or a full revision is needed. This process gives priority to areas in which major changes in text, and particularly recommendations, are merited on the basis of new understanding or evidence. Minor changes in verbiage and references are discouraged. The ACC/AHA/American College of Physicians–American Society of Internal Medicine (ACP-ASIM) Guidelines for the Management of Patients With Chronic Stable Angina, which were published in June 1999, have now been updated. The full-text guideline incorporating the updated material is available on the Internet (www.acc.org or www.americanheart.org) in both a track-changes version showing the changes in the 1999 guideline in strike-out (deleted text) and highlighting …
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acc aha acp asim guidelines for the management of patients with chronic Stable Angina executive summary and recommendations a report of the american college of cardiology american heart association task force on practice guidelines committee on management of patients with chronic Stable Angina
Circulation, 1999Co-Authors: Raymond J Gibbons, Kanu Chatterjee, Jennifer Daley, John S Douglas, Stephan D Fihn, Julius M Gardin, M A Grunwald, Dror Levy, Bruce W Lytle, Robert A OrourkeAbstract:### A. Organization of Committee and Evidence Review The American College of Cardiology/American Heart Association (ACC/AHA) Task Force on Practice Guidelines was formed to make recommendations regarding the diagnosis and treatment of patients with known or suspected cardiovascular disease. Ischemic heart disease is the single leading cause of death in the United States. The most common manifestation of this disease is chronic Stable Angina. Recognizing the importance of the management of this common entity and the absence of national clinical practice guidelines in this area, the task force formed the Committee on Management of Patients With Chronic Stable Angina to develop guidelines for the management of Stable Angina. Because this problem is frequently encountered in the practice of internal medicine, the task force invited the American College of Physicians–American Society of Internal Medicine (ACP–ASIM) to serve as a partner in this effort by identifying 3 general internists to serve on the committee. The guidelines are arbitrarily divided into 4 sections: diagnosis, risk stratification, treatment, and patient follow-up. Experienced clinicians will quickly recognize that the distinctions between these sections may be arbitrary and unrealistic for individual patients. However, for most clinical decision making, these divisions are helpful and facilitate the presentation and analysis of the available evidence. Detailed evidence was developed whenever possible. The weight of the evidence was ranked highest (A) if the data were derived from multiple randomized clinical trials involving large numbers of patients and intermediate (B) if the data were derived from a limited number of randomized trials involving small numbers of patients or careful analyses of nonrandomized studies or observational regis-tries. A low rank (C) was given when expert consensus was the primary basis for the recommendation. The customary ACC/AHA classifications I, II, and III are used in tables that summarize both the evidence and expert opinion and provide final recommendations for both patient …
Raymond J Gibbons - One of the best experts on this subject based on the ideXlab platform.
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acc aha 2002 guideline update for the management of patients with chronic Stable Angina summary article a report of the american college of cardiology american heart association task force on practice guidelines committee on the management of patients with chronic Stable Angina
Circulation, 2003Co-Authors: Raymond J Gibbons, Jonathan Abrams, Kanu Chatterjee, Jennifer Daley, Prakash Deedwania, John S Douglas, Bruce T Ferguson, Stephan D Fihn, Theodore D Fraker, Julius M GardinAbstract:The Clinical Efficacy Assessment Subcommittee of the American College of Physicians–American Society of Internal Medicine acknowledges the scientific validity of this product as a background paper and as a review that captures the levels of evidence in the management of patients with chronic Stable Angina as of November 17, 2002. The American College of Cardiology (ACC)/American Heart Association (AHA) Task Force on Practice Guidelines regularly reviews existing guidelines to determine when an update or a full revision is needed. This process gives priority to areas in which major changes in text, and particularly recommendations, are merited on the basis of new understanding or evidence. Minor changes in verbiage and references are discouraged. The ACC/AHA/American College of Physicians–American Society of Internal Medicine (ACP-ASIM) Guidelines for the Management of Patients With Chronic Stable Angina, which were published in June 1999, have now been updated. The full-text guideline incorporating the updated material is available on the Internet (www.acc.org or www.americanheart.org) in both a track-changes version showing the changes in the 1999 guideline in strike-out (deleted text) and highlighting …
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acc aha acp asim guidelines for the management of patients with chronic Stable Angina executive summary and recommendations a report of the american college of cardiology american heart association task force on practice guidelines committee on management of patients with chronic Stable Angina
Circulation, 1999Co-Authors: Raymond J Gibbons, Kanu Chatterjee, Jennifer Daley, John S Douglas, Stephan D Fihn, Julius M Gardin, M A Grunwald, Dror Levy, Bruce W Lytle, Robert A OrourkeAbstract:### A. Organization of Committee and Evidence Review The American College of Cardiology/American Heart Association (ACC/AHA) Task Force on Practice Guidelines was formed to make recommendations regarding the diagnosis and treatment of patients with known or suspected cardiovascular disease. Ischemic heart disease is the single leading cause of death in the United States. The most common manifestation of this disease is chronic Stable Angina. Recognizing the importance of the management of this common entity and the absence of national clinical practice guidelines in this area, the task force formed the Committee on Management of Patients With Chronic Stable Angina to develop guidelines for the management of Stable Angina. Because this problem is frequently encountered in the practice of internal medicine, the task force invited the American College of Physicians–American Society of Internal Medicine (ACP–ASIM) to serve as a partner in this effort by identifying 3 general internists to serve on the committee. The guidelines are arbitrarily divided into 4 sections: diagnosis, risk stratification, treatment, and patient follow-up. Experienced clinicians will quickly recognize that the distinctions between these sections may be arbitrary and unrealistic for individual patients. However, for most clinical decision making, these divisions are helpful and facilitate the presentation and analysis of the available evidence. Detailed evidence was developed whenever possible. The weight of the evidence was ranked highest (A) if the data were derived from multiple randomized clinical trials involving large numbers of patients and intermediate (B) if the data were derived from a limited number of randomized trials involving small numbers of patients or careful analyses of nonrandomized studies or observational regis-tries. A low rank (C) was given when expert consensus was the primary basis for the recommendation. The customary ACC/AHA classifications I, II, and III are used in tables that summarize both the evidence and expert opinion and provide final recommendations for both patient …
Juan Carlos Kaski - One of the best experts on this subject based on the ideXlab platform.
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nicorandil and long acting nitrates vasodilator therapies for the management of chronic Stable Angina pectoris
European Cardiology Review, 2018Co-Authors: Jason M Tarkin, Juan Carlos KaskiAbstract:Nicorandil and long-acting nitrates are vasodilatory drugs used commonly in the management of chronic Stable Angina pectoris. Both nicorandil and long-acting nitrates exert anti-Angina properties via activation of nitric oxide (NO) signalling pathways, triggering vascular smooth muscle cell relaxation. Nicorandil has additional actions as an arterial K+ ATP channel agonist, resulting in more "balanced" arterial and venous vasodilatation than nitrates. Ultimately, these drugs prevent Angina symptoms through reductions in preload and diastolic wall tension and, to a lesser extent, epicardial coronary artery dilatation and lowering of systemic blood pressure. While there is some evidence to suggest a modest reduction in cardiovascular events among patients with Stable Angina treated with nicorandil compared to placebo, this prognostic benefit has yet to be proven conclusively. In contrast, there is emerging evidence to suggest that chronic use of long-acting nitrates might cause endothelial dysfunction and increased cardiovascular risk in some patients.
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pharmacological treatment of chronic Stable Angina pectoris
Clinical Medicine, 2013Co-Authors: Jason M Tarkin, Juan Carlos KaskiAbstract:Chronic Stable Angina is the most common manifestation of ischaemic heart disease in the developed world and is associated with impaired quality of life and increased mortality. The pathogenesis of Stable Angina is complex and often, albeit not always, involves flow-limiting epicardial coronary artery stenoses (atheromatous plaques) that reduce the ability of the coronary circulation to deliver appropriate blood supply to the myocardium. The coronary microcirculation can also play an important role. An imbalance between myocardial oxygen supply and metabolic oxygen demand causes the symptoms of Angina pectoris and represents a major therapeutic target. Rational treatment requires a multi-faceted approach combining lifestyle changes, aggressive management of modifiable coronary artery disease risk factors, pharmacological therapy and myocardial revascularisation when appropriate. Despite modern therapies, many patients continue to suffer from Angina. Several new anti-Anginal drugs have been introduced that might allow more effective symptom control. These novel agents have specific mechanisms of action and fewer side effects compared to conventional drugs. The combined use of traditional and novel treatments is likely to increase the proportion of patients who are managed successfully with medical therapy alone. This article briefly reviews recent advances in the pharmacological management of chronic Stable Angina pectoris, highlighting how an understanding of the prevailing pathogenic mechanisms in the individual patient can aid appropriate selection of therapeutic strategies and improve clinical outcome.
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elevated serum neopterin predicts future adverse cardiac events in patients with chronic Stable Angina pectoris
European Heart Journal, 2005Co-Authors: Pablo Avanzas, Ramon Arroyoespliguero, Juan Quiles, Debashis Roy, Juan Carlos KaskiAbstract:Aims Serum levels of neopterin, an immune modulator secreted by activated macrophages, are elevated in patients with acute coronary syndromes compared with Stable Angina patients and control subjects. In unStable Angina, serum neopterin levels correlate with the presence of vulnerable coronary stenosis, multiple complex coronary lesions, and patient outcome. The present study assessed the prognostic significance of raised serum neopterin concentrations in patients with Stable Angina pectoris. Methods and results We carried out a 1-year follow-up prospective study in 297 patients with chronic Stable chest pain undergoing diagnostic coronary angiography. The primary study endpoint was the composite of non-fatal myocardial infarction, unStable Angina, and cardiac death. Fifty-one patients (17.2%) had adverse coronary events during follow-up. Mean serum neopterin levels were significantly higher in patients with events compared with those without ( P =0.02). On multiple regression analysis, neopterin levels ( P =0.021), severity of coronary artery disease ( P =0.009), and a history of previous myocardial infarction ( P =0.001) were independent predictors of adverse events. Conclusions Serum neopterin is an independent predictor of major adverse coronary events in patients with chronic Stable Angina pectoris. This marker of macrophage activation may be useful for risk stratification in patients with chronic Stable Angina.
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markers of inflammation and rapid coronary artery disease progression in patients with Stable Angina pectoris
Circulation, 2004Co-Authors: Emmanouil Zouridakis, Pablo Avanzas, Ramon Arroyoespliguero, Salim Fredericks, Juan Carlos KaskiAbstract:Background— Both endothelial cell activation and macrophage activation play a significant role in atherogenesis and atheromatous plaque vulnerability and may determine rapid coronary artery disease (CAD) progression. We sought to assess the association between serum inflammatory markers and rapid CAD progression in patients with chronic Stable Angina pectoris. Methods and Results— We studied 124 chronic Stable Angina pectoris patients (84 men; mean age, 61±10 years) who were on a waiting list for coronary angioplasty for a mean time of 4.8±2.4 months. CAD progression was defined as ≥10% diameter reduction of a pre-existing stenosis ≥50%, ≥30% diameter reduction of a stenosis <50%, development of a new stenosis ≥30% in a previously normal segment, or progression of any stenosis to total occlusion. CAD progression occurred in 35 patients (28%). After adjustment with binary logistic regression, neopterin (P<0.001), high-sensitivity C-reactive protein (P=0.017), matrix metalloproteinase-9 (P=0.002), soluble i...
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a comparative study of eccentric and concentric coronary stenosis vasomotion in patients with prinzmetal s variant Angina and patients with Stable Angina pectoris
Clinical Cardiology, 1998Co-Authors: Dimitris Tousoulis, Graham Daves, Juan Carlos KaskiAbstract:BACKGROUND AND HYPOTHESIS: In patients with Stable Angina pectoris, eccentric stenoses have a greater potential for dynamic changes of caliber in response to vasoactive stimuli than concentric lesions. It is not known whether in patients with coronary artery spasm the degree of coronary vasoconstriction differs in eccentric versus concentric stenoses. Therefore, we examined the relationship between coronary stenosis morphology and the vasomotor response to vasoactive stimuli in patients with variant Angina. METHODS: Computerized quantitative angiography was used to measure minimum luminal diameter of eccentric and concentric stenoses before and after the administration of ergonovine and isosorbide dinitrate in 22 patients with Prinzmetal's variant Angina and in 20 patients with chronic Stable Angina. RESULTS: In patients with variant Angina, mean stenosis diameter reduction with ergonovine was -0.85 +/- 0.38 and -1.12 +/- 0.69 mm in eccentric and concentric stenoses, respectively (p = NS). Isosorbide dinitrate promptly relieved spasm in all patients and increased the diameter of eccentric stenoses by 0.26 +/- 0.34 mm and that of concentric stenoses by 0.24 +/- 0.32 mm (p = NS). In patients with chronic Stable Angina, mean diameter reduction with ergonovine was -0.23 +/- 0.12 and -0.12 +/- 0.10 mm for eccentric and concentric stenoses, respectively (p < 0.05). Isosorbide dinitrate increased coronary diameter by 10% from baseline in 70% of eccentric and 38% of concentric stenoses (p < 0.01). CONCLUSION: In patients with variant Angina pectoris, eccentric and concentric spastic stenoses react similarly in response to vasoactive stimuli. In patients with chronic Stable Angina, eccentric stenoses are more likely to show vasomotor responses than concentric stenoses.
